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Annals of Medicine Dec 2021In puerperium, the hypoestrogenic state induced by delivery and subsequently sustained by lactation may lead to vaginal dryness, burning, and itching sensation,... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
In puerperium, the hypoestrogenic state induced by delivery and subsequently sustained by lactation may lead to vaginal dryness, burning, and itching sensation, contributing to the onset of sexual dysfunction.
MATERIAL AND METHODS
This was a prospective, randomized, controlled, open-label study (NCT04560283) for evaluating the effects of application of a prolonged-release hyaluronic acid derivative vaginal gel in restoring sexual function during the postpartum period. Eighty-five patients were randomized to apply prolonged-release Hydeal-D 0.2% vaginal gel (Fidia Farmaceutici, Abano Terme, Italy; = 43) every three days for 12 consecutive weeks or expectant management ( = 42).
RESULTS
Women undergoing treatment had a more elevate increase in Female Sexual Function Index (FSFI) total score (+15.1 ± 11.9 vs +6.5 ± 8.9, < 0.001) and a higher decrease in vaginal pH (-1.2 ± 0.7 vs -0.2 ± 1.1; < 0.001). Moreover, the proportion of vaginal smears with maturation index (VMI) >65 was significantly higher in patients treated (80.6% vs 35.3%; = 0.004). Edinburgh Postnatal Depression Scale (EPDS) decreased significantly in both groups with no inter-group difference ( = 0.459). Only two cases (4.8%) of moderate vaginal burning sensation were reported in patients undergoing local vaginal therapy.
CONCLUSIONS
The results of our study demonstrated that hyaluronic acid derivative vaginal gel (Hydeal-D) was able to improve sexual function of puerperal women in the short-term treatment.KEY MESSAGEIn the puerperium, the hypoestrogenic state induced by delivery and subsequently sustained by lactation may lead to vaginal dryness, burning, and itching sensation, contributing to the onset of sexual dysfunction.Hydeal-D is a prolonged-release hyaluronic acid derivative characterised by elevated resistance to enzymatic breakdown. During puerperium, its local application may improve the vaginal microenvironment by ensuring a better migration and proliferation of cells involved in local tissue repair.Among puerperal women, Hydeal-D vaginal gel causes a significant improvement of sexual function, including desire, arousal, and lubrification, compared to expectant management. Furthermore, it leads to a decrease in vaginal pH and an increase of the trophic status of vaginal epithelium.
Topics: Adult; Depression, Postpartum; Female; Humans; Hyaluronic Acid; Italy; Postpartum Period; Prospective Studies; Pruritus; Sexual Dysfunction, Physiological; Vaginal Creams, Foams, and Jellies; Vaginal Diseases
PubMed: 34477473
DOI: 10.1080/07853890.2021.1974083 -
JSLS : Journal of the Society of... 2023Determine the difference in microbial growth from the vagina and uterine manipulator among patients undergoing laparoscopic hysterectomy after randomization to one of... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Determine the difference in microbial growth from the vagina and uterine manipulator among patients undergoing laparoscopic hysterectomy after randomization to one of three vaginal preparation solutions (10% Povidone-iodine, 2% Chlorhexidine, or 4% Chlorhexidine).
METHOD
This was a prospective randomized controlled trial in an academic community hospital. Patients were ≥ 18 years old and scheduled for laparoscopic hysterectomy for benign and malignant indications.
RESULTS
Fifty patients were identified and randomized into each arm. Prior to surgery, the surgical team prepared the vaginal field using 10% Povidone-iodine, 2% Chlorhexidine, or 4% Chlorhexidine, according to group assignment. Cultures were collected from the vagina after initial preparation, prior to the colpotomy, and on surfaces of the uterine manipulator. Bacterial count from the baseline vaginal fornix/cervical canal cultures did not differ significantly among the three groups. There was a difference in bacterial count among the second cervical canal/vaginal fornix cultures (p < 0.01), with the Povidone-iodine arm demonstrating the highest level of growth of cultures (93.8%), followed by 2% Chlorhexidine (47.4%), and 4% Chlorhexidine (20%). There was no difference in growth on the uterine manipulator handle and no difference in vaginal itching or burning was found across the three arms postoperatively.
CONCLUSION
Bacterial growth prior to colpotomy was the lowest with 4% Chlorhexidine followed by 2% Chlorhexidine, the Povidone-iodine group exhibited the highest bacterial growth. There was no difference in moderate to severe vaginal itching or burning. This showed that 4% Chlorhexidine is superior in reducing bacterial growth when used in laparoscopic hysterectomy.
Topics: Female; Humans; Adolescent; Povidone-Iodine; Chlorhexidine; Prospective Studies; Hysterectomy; Vagina; Laparoscopy; Pruritus; Hysterectomy, Vaginal
PubMed: 37663434
DOI: 10.4293/JSLS.2023.00013 -
The Pan African Medical Journal 2021Gonorrhea is all diseases caused by Neisseria gonorrhoeae. Prepubertal child is more susceptible to N. gonorrhoeae infection because the vagina is alkaline and contains...
Gonorrhea is all diseases caused by Neisseria gonorrhoeae. Prepubertal child is more susceptible to N. gonorrhoeae infection because the vagina is alkaline and contains no estrogen. Gonorrhea vaginitis is the most common form of gonorrhoea in prepubertal children beyond neonatal period. Transmission in child can be through sexual contact (abuse) or non-sexual contact. Gonorrhea vaginitis in children more often asymptomatic, with clinical manifestation such as mucopurulent discharge, vaginal pruritus and vulval erythema. Supporting examination comprise of gram staining from vaginal discharge, culture and nucleic acid amplification testing (NAAT). Ceftriaxone is drug of choice gonorrhea without complication in children. We report a case of 4 year and 9-month female girl that was diagnosed by history taking and supporting examination from gram staining and polymerase chain reaction (PCR) from vaginal discharge, and then treated with single dose ceftriaxone 125 mg intramuscular that gave clinical improvement.
Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Female; Gonorrhea; Humans; Neisseria gonorrhoeae; Polymerase Chain Reaction; Vaginosis, Bacterial
PubMed: 34367437
DOI: 10.11604/pamj.2021.38.358.28390 -
The Journal of International Medical... May 2021To assess the efficacy, acceptability, and tolerability of a vaginal cream based on plant extracts for treating signs and symptoms of vulvovaginitis (VV) (Zelesse... (Observational Study)
Observational Study
OBJECTIVE
To assess the efficacy, acceptability, and tolerability of a vaginal cream based on plant extracts for treating signs and symptoms of vulvovaginitis (VV) (Zelesse cream®), either as monotherapy (non-infectious VV) or adjuvant to antimicrobial therapy (infectious VV).
METHODS
This prospective, observational, multicenter study included women who attended outpatient offices for VV. The severity of signs (vaginal discharge, erythema, and edema) and symptoms (pruritus, burning, and dysuria) was assessed before and after 15±5 days of daily treatment with Zelesse cream on a 4-point scale (18-point global score).
RESULTS
The study included 58 women aged 43.0±13.2 years, including 42 who were treated with Zelesse cream only and 16 who used Zelesse cream as adjuvant to antimicrobial therapy. All participants showed significantly reduced scores and absolute prevalence of individual signs and symptoms in both groups. Similarly, the median signs/symptoms decreased by 4.0 and 8.0 points in women using Zelesse only and those using Zelesse plus antimicrobial therapy, respectively. This product was well tolerated and had high acceptability.
CONCLUSIONS
Zelesse cream relieves signs and symptoms of VV, either as monotherapy in non-infectious VV or as adjuvant to antimicrobial therapy in infectious VV. Future randomized, placebo-controlled trials with larger sample sizes are warranted.
Topics: Administration, Intravaginal; Adult; Female; Humans; Middle Aged; Ointments; Prospective Studies; Treatment Outcome; Vaginal Creams, Foams, and Jellies; Vulvovaginitis
PubMed: 33983051
DOI: 10.1177/03000605211013226 -
BMC Women's Health Aug 2021Vulvo-vaginal atrophy (VVA) is one of the common consequences of estrogen deficiency especially after the menopause. Several studies have assessed the effects of...
Evaluation of the effect of multipoint intra-mucosal vaginal injection of a specific cross-linked hyaluronic acid for vulvovaginal atrophy: a prospective bi-centric pilot study.
BACKGROUND
Vulvo-vaginal atrophy (VVA) is one of the common consequences of estrogen deficiency especially after the menopause. Several studies have assessed the effects of Hyaluronic acid (HA) on physical and sexual symptoms associated with VVA with promising results. However, most of these studies have focused on subjective assessment of symptom response to topically administered preparations. Nonetheless, HA is an endogenous molecule and it is logical that its effects are best realized if injected in the superficial epithelial layers. Desirial® is the first crosslinked HA that is administered by injection in the vaginal mucosa. The aim of this study was to explore the effect of multipoint vaginal intra-mucosal injections of specific cross-linked hyaluronic acid (DESIRIAL®, Laboratoires VIVACY) on several clinical and patient reported core outcomes.
METHODS
A cohort bi-centric pilot study. The chosen outcomes included change in vaginal mucosa thickness, biological markers for collagen formation, vaginal flora, vaginal pH, vaginal health index, vulvo-vaginal atrophy symptoms and sexual function 8 weeks post Desirial® injection. Patients' satisfaction was also assessed using the patient global impression of improvement (PGI-I) scale.
RESULTS
A total of 20 participants were recruited between 19/06/2017 and 05/07/2018. At the end of the study, there was no difference in the median total thickness of the vaginal mucosa or in procollagen I, III or Ki67 fluorescence. However, there was a statistically significant increase in COL1A1 and COL3A1 gene expression (p = 0.0002 and p = 0.0010 respectively). There was also a significant reduction in reported dyspareunia, vaginal dryness, vulvar pruritus, vaginal chafing and significant improvement in all female sexual function index dimensions. Based on PGI-I, 19 patients (95%) reported varying degrees of improvement where, 4 (20%) felt slightly better; 7 (35%) better and 8 (40%) much better.
CONCLUSIONS
Multi-point vaginal intra-mucosal injections, of Desirial® (a crosslinked HA) was significantly associated with the expression of CoL1A1 and CoL3A1 suggesting stimulation of collagen formation. Furthermore, there was a significant reduction in VVA symptomatology and a significant improvement in patient satisfaction and sexual function scores. However, there was no demonstrable change in the total vaginal mucosal thickness. Study registration ID-RCB: 2016-A00124-47, Protocol code number: LOCAL/2016/PM-001.
Topics: Atrophy; Dyspareunia; Female; Humans; Hyaluronic Acid; Mucous Membrane; Pilot Projects; Postmenopause; Prospective Studies; Treatment Outcome; Vagina; Vaginal Diseases
PubMed: 34454465
DOI: 10.1186/s12905-021-01435-w -
Anaesthesia Sep 2019Patient-centred care and factors associated with patient satisfaction with anaesthesia have been widely studied. However, the most important considerations in the... (Observational Study)
Observational Study
Patient-centred care and factors associated with patient satisfaction with anaesthesia have been widely studied. However, the most important considerations in the setting of obstetric anaesthesia are uncertain. Identification of, and addressing, factors that contribute to patient dissatisfaction may improve quality of care. We sought to identify factors associated with < 100% satisfaction with obstetric anaesthesia care. At total of 4297 women treated by anaesthetists provided satisfaction data 24 h after vaginal and 48 h after caesarean delivery. As 78% of women were 100% satisfied, we studied factors associated with the dichotomous variable, 100% satisfied vs. < 100% satisfied. We evaluated patient characteristics and peripartum factors using multivariable sequential logistic regression. The following factors were strongly associated with maternal dissatisfaction after vaginal delivery: pain intensity during the first stage of labour; pain intensity during the second stage of labour; postpartum pain intensity; delay > 15 min in providing epidural analgesia and postpartum headache (all p < 0.0001). Pruritus (p = 0.005) also contributed to dissatisfaction after vaginal delivery, whereas non-Hispanic ethnicity was negatively associated with dissatisfaction (p = 0.01). After caesarean delivery, the intensity of postpartum pain (p < 0.0001), headache (p = 0.001) and pruritus (p = 0.001) were linked to dissatisfaction. Hispanic ethnicity also had a negative relationship with dissatisfaction after caesarean delivery (p = 0.005). Thus, inadequate or delayed analgesia and treatment-related side-effects are associated with maternal dissatisfaction with obstetric anaesthesia care. Development of protocols to facilitate identification of ineffective analgesia and provide an appropriate balance between efficacy and side-effects, are important goals to optimise maternal satisfaction.
Topics: Adult; Anesthesia, Obstetrical; Delivery, Obstetric; Female; Humans; Labor Pain; Labor, Obstetric; Patient Satisfaction; Pregnancy; Retrospective Studies
PubMed: 31264207
DOI: 10.1111/anae.14756 -
Alternative Therapies in Health and... Sep 2023To investigate the effect of Wandai decoction combined with traditional Chinese medicine fumigation and washing in patients with chronic vaginitis after sintilimab...
Efficacy Analysis of Wandai Decoction Combined with Traditional Chinese Medicine Fumigation and Washing in Patients with Chronic Vaginitis After Sintilimab Treatment for Small Cell Lung Cancer.
OBJECTIVE
To investigate the effect of Wandai decoction combined with traditional Chinese medicine fumigation and washing in patients with chronic vaginitis after sintilimab treatment for small cell lung cancer.
METHODS
We recruited 80 patients who developed chronic vaginitis after sintilimab treatment for small cell lung cancer from Hainan General Hospital from January 2020 to June 2022; using a random number table, 40 were assigned to a control group and 40 were assigned to an observation group. The control group was treated with Wandai decoction, and the observation group was treated with Wandai decoction combined with traditional Chinese medicine fumigation and washing. The 2 groups were compared for improvement of the symptoms of vulvar pruritus subsidence time, leukorrhea recovery time, and traditional Chinese medicine symptom score; levels of the vaginal microecological environment factors immunoglobulin G, secretory immunoglobulin A, and pH; levels of the serum inflammatory factors C-reactive protein, tumor necrosis factor, and interleukin-6; and clinical efficacy.
RESULTS
After treatment, the observation group had significantly higher vulvar pruritus subsidence time, leukorrhea recovery time, traditional Chinese medicine symptom score, and pH value; significantly lower levels of C-reactive protein, tumor necrosis factor, and interleukin-6; and significantly higher levels of immunoglobulin G, secretory immunoglobulin A, and total effective rate compared with the control group (all P < .0.001).
CONCLUSIONS
Wandai decoction combined with traditional Chinese medicine fumigation and washing was effective in treating chronic vaginitis after sintilimab treatment for small cell lung cancer. The treatment ameliorated symptoms of leukorrhea abnormalities, vulvar pruritus, and local inflammation, and promoted the recovery of the vaginal microbial environment. Despite the limitations of our study (small sample size and lack of comparison between different types of chronic vaginitis, which hinders the confirmation of extensive efficacy), we consider Wandai decoction combined with traditional Chinese medicine fumigation and washing worthy of promotion and application in clinical practice.
Topics: Female; Humans; Leukorrhea; Small Cell Lung Carcinoma; C-Reactive Protein; Fumigation; Interleukin-6; Medicine, Chinese Traditional; Vaginitis; Tumor Necrosis Factors; Immunoglobulin A, Secretory; Immunoglobulin G; Lung Neoplasms; Pruritus
PubMed: 37318889
DOI: No ID Found -
Taiwanese Journal of Obstetrics &... Sep 2021We report a case of diffuse large B-cell urethral lymphoma initial presenting with non-healing urethra ulcer. (Review)
Review
OBJECTIVE
We report a case of diffuse large B-cell urethral lymphoma initial presenting with non-healing urethra ulcer.
CASE REPORT
A 68-year-old woman presented with a non-healing urethral ulcer accompanied with vulvar pruritus, which failed to medical treatment. Her medical history was unremarkable, lacking fever, weight loss or unexplained fatigue. There were no enlarged lymph nodes or palpable liver or spleen upon physical examination. Pelvic examination revealed an ulcerative lesion arising from the posterior wall of the urethral meatus. Cystourethroscopy showed no bladder involvement. Surgical excision of the urethral ulcer was done and immunohistochemical report showed a diffuse large B-cell lymphoma. Bone marrow needle biopsy and computed tomography were done and the diagnosis of primary diffuse large B-cell urethral lymphoma stage IEA was made. She underwent six cycles of cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab and was free of disease for 51 months.
CONCLUSION
This report of urethral lymphoma was presented as a non-healing ulcer initially, which was totally different previous reports, presenting with bleeding, either vaginal or urinary, urinary frequency, dysuria, urine retention and self-perceived mass, suggesting that unhealed ulcer on the perineal area should be promptly evaluated and avoidance of unnecessary delayed therapy for possible curable disease.
Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Cyclophosphamide; Female; Humans; Lymphoma, Large B-Cell, Diffuse; Ulcer; Urethra; Urethral Neoplasms; Vincristine
PubMed: 34507675
DOI: 10.1016/j.tjog.2021.07.025 -
Obstetrics and Gynecology Jun 2021To evaluate the histologic response rate of high-grade squamous intraepithelial lesions (HSIL) of the cervix after topical application of 5% imiquimod cream. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the histologic response rate of high-grade squamous intraepithelial lesions (HSIL) of the cervix after topical application of 5% imiquimod cream.
METHODS
In this phase II trial, women with cervical HSIL (cervical intraepithelial neoplasia [CIN] 2-3) were randomly assigned to 250 mg of 5% imiquimod cream applied to the cervix weekly for 12 weeks, followed by loop electrosurgical excision procedure (LEEP) without preceding treatment. The sample size was calculated based on the HSIL regression rates previously reported by Grimm et al. The primary outcome was rate of histologic regression (to CIN 1 or less) in LEEP specimens. Prespecified secondary endpoints included surgical margin status and adverse events. Outcomes were stratified by human papillomavirus type and lesion grade (CIN 2 or CIN 3). Results were reported according to per protocol (PP) and intention-to-treat (ITT) analyses.
RESULTS
Ninety women were enrolled: 49 in the experimental group and 41 in the control group. In the PP population, histologic regression was observed in 23 of 38 participants (61%) in the experimental group compared with 9 of 40 (23%) in the control group (P=.001). Surgical margins were negative for HSIL in 36 of 38 participants (95%) in the experimental group and 28 of 40 (70%) in the control group (P=.004). In the ITT population, rates of histologic regression also were significantly higher in the experimental group. Rates of adverse events in the experimental group were 74% (28/38) in the PP population and 78% (35/45) in the ITT population. Adverse events were mild, with abdominal pain being the most common. Three patients in the experimental group had grade 2 adverse events, including vaginal ulcer, vaginal pruritus with local edema, and moderate pelvic pain.
CONCLUSION
Weekly topical treatment with imiquimod is effective in promoting regression of cervical HSIL.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT03233412.
Topics: Administration, Topical; Adult; Antineoplastic Agents; Combined Modality Therapy; Electrosurgery; Female; Humans; Imiquimod; Intention to Treat Analysis; Margins of Excision; Middle Aged; Neoplasm Grading; Papillomavirus Infections; Squamous Intraepithelial Lesions of the Cervix; Uterine Cervical Neoplasms; Young Adult; Uterine Cervical Dysplasia
PubMed: 33957649
DOI: 10.1097/AOG.0000000000004384 -
Journal of Inflammation Research 2022Buch.-Ham () belongs to the Compositae family. As a Traditional Chinese medicine, has been used in China to treat conjunctivitis, mastitis and vaginitis, it also has...
BACKGROUND
Buch.-Ham () belongs to the Compositae family. As a Traditional Chinese medicine, has been used in China to treat conjunctivitis, mastitis and vaginitis, it also has the function of antibacterial and relieving itching.
METHODS
Water extract of (WSS) was prepared and its quality was controlled by HPLC. The antipruritic effects of WSS were evaluated by itch behavioral experiments. The oxazolone and compound 48/80 were induced to mice scratch behavior, scratch was recorded 30 min after sensitization. The relationship between the antipruritic mechanism and MrgprB2 on mast cell was studied by using mast cell-deficient Kit (W-sh) "Sash" mice and MrgprB2 mice. The mast cells were observed by toluidine blue staining. In vitro, the effects of WSS on MrgprB2 were studied by calcium imaging; The whole-cell patch clamp method recorded the MrgprB2 mediate voltage-dependent currents in mast cells.
RESULTS
The content of rutin (0.012%) and hyperin (0.014%) in the WSS were determined. WSS could ameliorate the pruritus induced by Oxazolone (inhibition was 41.19%, = 0.004) and compound 48/80 (inhibition was 50.29%, = 0.001). Meanwhile, WSS could reduce the number of mast cells in mice skin tissue with allergic contact dermatitis (ACD) ( = 0.002) or compound 48/80 ( = 0.013). In addition, WSS could inhibit the calcium influx (1 mg/mL: = 0.001, 3 mg/mL: < 0.0001) and the voltage-dependent currents induced by activation of MrgprB2 on mast cell. WSS also attenuated the calcium influx induced by compound 48/80 in HEK293 cells overexpressing MrgprB2/X2.
CONCLUSION
These results showed that WSS could ameliorate pruritus by inhibiting MrgprB2 receptor on mast cells.
PubMed: 36324862
DOI: 10.2147/JIR.S384661